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Steroids - best dose?

I’m going to ask GP for steroids. In the past, he has prescribed 14 days of 50mg Prednisolone. Last time I saw neuro, he said he would have prescribed 5 days of 500mg methylprednisolone instead. Seems a lot !

Does anyone know which dose is likely to be best ? When on the 50mg course I tapered the dose for a further week and avoided the ‘crash’. Would I be best to use a taper dose after 5 days of 500mg ? Any advice welcome!

John H

John

i have always had 5 days of 500mg a day with no tapering off.

it has generally speeded up recovery.

all the best

neil

I have only once had five days at 500mg and I crashed big time day after I stopped taking them. If I ever get as bad as I was when I came off them I might consider taking them again but only if I could wean off them.

Hi John,

Like Neil I have had 5 days of 500mg with no tapering off. Take the five100mg tablets all at once usually with breakfast-plus you need omeprazole tablets to take alongside to protect your stomach lining. When my neuro first prescribed these my GP rang him in my presence to check the dose as it is such a big dose-but it is correct. Also each time I have had these (3 times) the chemist had to order them in as they didn’t stock in such high dosage so be aware it may take a day to get hold of them.

Cathy

Those lower doses are not as fashionable as they were for an acute relapse.

When I was first dx in 1999, it was still routine for neuros to prescribe fairly dainty little doses of oral steroids for a relapse, with a taper-off and so on. I remember counting out those wee 1mg tablets to make them add up to the exact amount set down for that day! Thinking has changed a lot since then, and a 3 or 5-day high-dose blast has been the norm for a little while now (and I’ve had that a couple of times over the years).

I’ve just been over to the NICE website to look at the hot-off-the-press Oct 2014 MS treatment guidelines (CG186) that replace the 2003 version (which also recommended high-dose, I think, although I haven’t checked that). Here’s a copy and paste from the new guidelines:

’Treating a relapse

1.7.7Offer treatment for relapse of MS with oral methylprednisolone 0.5 g daily for 5 days.

1.7.8Consider intravenous methylprednisolone 1 g daily for 3–5 days as an alternative for people with MS:

  • in whom oral steroids have failed or not been tolerated or

  • who need admitting to hospital for a severe relapse or monitoring of medical or psychological conditions such as diabetes or depression.

1.7.9Do not prescribe steroids at lower doses than methylprednisolone 0.5 g daily for 5 days to treat an acute relapse of MS.

1.7.10Do not give people with MS a supply of steroids to self‑administer at home for future relapses.'

And here’s the link to the source document: Recommendations | Multiple sclerosis in adults: management | Guidance | NICE

​Whatever dose your GP thinks is right for you, I hope that it does the trick.

Alison